Study on High Risk Behaviour among Adolescents Male and Females of Agra Urban Slums

Background: India estimates third highest number of HIVinfections in the world Adolescents often face significant barrierto getting the information education and services they need.Since discussing reproductive and sexual matter freely is still ataboo in our society. Most of the literature reports that majorityof married or unmarried people had experienced their first sexencounter before age 20. The most of the countries developedor developing especially those with high prevalence ofHIV/AIDS. The intervention in India are directed more towardshigh risk groups rather than adolescents, there has been anincrease in efforts to raise awareness on issues of HIV/AIDSand to influence preventive behaviour particularly regardingsexual activity in vulnerable age group.Methods: The study was performed among adolescents of 13-19years age group residing in randomly selected urban slumsof Agra city. Personal in-depth interview of adolescent’s boysand girls was conducted using a structured questionnaire.Results: Gutkha chewing habit appeared as an futuristicepidemic as 15.0% of adolescents Gutkha chewer, out ofwhich 84.44% were males, the majority of the adolescents71.67% had never seen pornographic films. The 88% ofadolescents said that they believe in religious customs andtaboos, out of which majority 51.89% were males. The sex withunknown status partner majority of adolescents 52% male saidto have sex only with use of condom, 43.33% expressed “nosex relation.Conclusions: The reproductive health education should be apart of curriculum in all schools. Public awareness programmeshould be directed to society. Apart from government sectors,the AIDS education should be programme activity of the localhealth agencies, NGO’s, media agencies.

Prevention of vertical transmission of HIV in India through service integration: lessons from Mysore District, Karnataka.

Meeting the needs of HIV‑positive pregnant women and their offspring is critical to India’s political and financial commitment to achieving universal access to HIV prevention, treatment, care and support. This review of the strategy to prevent vertical transmission of HIV in Mysore district, Karnataka, highlights the need to integrate prevention of parent‑to‑child transmission (PPTCT) and reproductive and child health (RCH) services. All key officials who were involved in the integration of services at the state and district levels were interviewed by use of semistructured protocols. Policy documents and guidelines issued by the Department of Health and Family Welfare and Karnataka State AIDS Prevention Society were reviewed, as were records and official orders issued by the office of District Health and Family Welfare Officer and District HIV/AIDS Programme Office, Mysore. Routine data were also collected from all health facilities. This review found that 4.5 years of PPTCT‑RCH integration resulted not only in a rise in antenatal registrations but also in almost all pregnant women counselled during antenatal care undergoing HIV tests. Based on the findings, we propose recommendations for successful replication of this strategy. Integration of PPTCT services with RCH should take place at all levels − policy, administration, facility and community. The increased demand for HIV counselling and testing resulting from service integration must be met by skilled human resources, sufficient facilities and adequate funds at the facility level.

Additional cash Incentive within a conditional cash transfer scheme: A 'controlled before and during' design evaluation study from India.

Background : Conditional Cash Transfer (CCT) schemes have shown largely favorable changes in the health seeking behavior. This evaluation study assesses the process and performance of an Additional Cash Incentive (ACI) scheme within an ongoing CCT scheme in India, and document lessons. Material and Methods: A controlled before and during design study was conducted in Madhya Pradesh state of India, from August 2007 to March 2008, with increased in institutional deliveries as a primary outcome. In depth interviews, focus group discussions and household surveys were done for data collection. Results: Lack of awareness about ACI scheme amongst general population and beneficiaries, cumbersome cash disbursement procedure, intricate eligibility criteria, extensive paper work, and insufficient focus on community involvement were the major implementation challenges. There were anecdotal reports of political interference and possible scope for corruption. At the end of implementation period, overall rate of institutional deliveries had increased in both target and control populations; however, the differences were not statistically significant. No cause and effect association could be proven by this study. Conclusions: Poor planning and coordination, and lack of public awareness about the scheme resulted in low utilization. Thus, proper IEC and training, detailed implementation plan, orientation training for implementer, sufficient budgetary allocation, and community participation should be an integral part for successful implementation of any such scheme. The lesson learned this evaluation study may be useful in any developing country setting and may be utilized for planning and implementation of any ACI scheme in future.

Primary health care and child survival in India.

The Primary Health Care (PHC) has been globally promoted as a comprehensive approach to achieve optimal health status and ‘Health for all’. The PHC approach, although, initially received the attention but failed to meet the expectations of the people in India. The child health programs in India had been started for long as verticals programs, which later on integrated and had been planned in a way to deliver the services through the PHC systems. Nevertheless, the last decade has witnessed many new initiatives for improving child health, specially; a number of strategies under National Rural Health Mission have been implemented to improve child survival- Skilled Birth Attendant and Emergency Obstetric Care, Home Based Newborn Care, Sick newborn care units, Integrated Management of Neonatal and Childhood Illnesses, strengthening Immunization services, setting up Nutritional rehabilitation centers etc. However, for a large proportion of rural population, an effective and efficient PHC system is the only way for service delivery, which still needs more attention. The authors note that although there have been improvements in infrastructure, community level health workers, and availability of the funding etc., the areas like community participation, district level health planning, data for action, inter-sectoral coordination, political commitment, public private partnership, accountability, and the improving health work force and need immediate attention, to strengthen the PHC system in the country, making it more child friendly and contributory in child survival, in India.

Possible role of male factors in recurrent pregnancy loss.

Objective : To evaluate various causes possibly contributing towards recurrent pregnancy loss (RPL), particularly male factors. Prospective study of 75 couples with history of RPL who were investigated for genetic, anatomic, immunological, infective and systemic causes in both partners. Functional sperm capacity was assessed by the Hypo-osmotic swelling test (HOS), Acrosomal Reaction (AR), Nuclear condensationdecondensation test (NCD) and Seminal Total Leukocyte Count (TLC) along with semen analysis. Twenty male volunteers with recently proven fertility were also included for detailed sperm morphology and sperm functions test as controls. Amongst male partners 3(4%) had varicocele, 23(30.6%) had infection, 1(1.3%) immunological and 1(1.3%) had genetic abnormality. Sperm motility, viability and sperm function tests were significantly lower in the RPL group as compared to the control group (P=0.000). Male factor might be a possible contributing factor towards RPL. Both the partners should be evaluated and treated simultaneously in order to achieve desirable outcome.

Rapid assessment of immunization practices in Agra district.

A cross sectional study was conducted utilizing rapid assessment procedures, covering 516 children of 12-23 months in 80 clusters of both urban and rural areas of district Agra. The results revealed that 41.5% had immunization cards; only 37.2% children were fully immunized and 37.6% children were unimmunized. 43.6% had received measles vaccine. The most common reason for non immunization was obstacles (46%), followed by lack of motivation (22.6%), lack of information (19.4%). 13.8% had received vitamin-A oil along with measles vaccine while only 5.3% had received vitamin A upto three years.

Maternal mortality in seven districts of Uttar Pradesh--an ICMR task force study.

Maternal mortality is a major health and development concern. The available information on maternal mortality in rural India is inadequate and scanty. This study presented maternal mortality data from the demographically and developmentally (including for health) poor performing state of Uttar Pradesh. A descriptive, cross-sectional survey was conducted utilizing a stratified cluster sampling design between 1989-90 in eight districts of Uttar Pradesh. Four good performing districts namely, Agra, Farrukhabad, Ghaziabad and Badaun from the western region and four poor performing districts from the eastern region namely, Gorakhpur, Basti, Varanasi and Pratapgarh were chosen. A door-to-door household interview survey was carried out in the selected villages covering a population of 11.67 lakhs in 889 villages. Maternal mortality rates during 1989 ranged between 533745 per 100,000 live births except in Ghaziabad district where the rate was as low as 101 per 100,000 live births. The rate in Eastern U.P. was higher (573 per 100,000 live births) as compared to that in Western U.P. (472 per 100,000 live births). A total of 286 maternal deaths were reported during the study period. The direct obstetric causes accounted for 55.7% of maternal deaths with haemorrhage (26.4%) being the most prevalent. Anaemia and jaundice (17.4%) were the most prevalent indirect causes of maternal deaths. Most of the maternal deaths could have been prevented if timely medical care was available.

National Rural Health Mission--"rhetoric or reality".

National Rural Health Mission (NRHM) launched by Government of India holds great hopes and promises to serve the deprived and underserved communities of rural areas. The backbone of the programme is Accredited Social Health Activist (ASHA), which will play major role in the implementation of the programme. The invariable existence of socio-cultural clusters in the community has always been a major challenge to the health care efforts made by the government. Though ASHA is a novel concept to melt the ice in the culture of silence among the various cluster community groups, it is important to emphasize that inter-cluster communication may still pose a problem, which ASHA may be unable to address. Considering the constraints of ASHA and success of cluster community approach in Unicef supported community based Maternal Child Health & Nutrition (MCHN) Project, it is quite reasonable to state that inclusion of community mobilisers (Bal Parivar Mitra) from within the cluster community group might well be an asset to the programme, who may actually bring about the task of spreading the spirit of NRHM. These set of functionaries may work in coordination to bring about the desired behaviour changes and decrease the social delays responsible for maternal and childhood mortality. It will also bring about the feeling of community participation and ownership. The programme is in its initial phase but has years ahead of it to bring visible changes at community level to make it a reality.